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There are many unanswered questions about the coronavirus. Scientists around the world are researching new tests, medications, and vaccines against SARS-CoV-2. An expert explains what approaches are available and how reliable the tests are.
The rheumatologist and immunologist Prof. Dr. Andreas Radbruch is currently a coveted man. Then already in Podcast “Knowledge of the soundtrack” He was a guest, speaking in an interview with t-online.de about the development of vaccines, the possible immunity in those who have recovered and the advantages and disadvantages of individual test procedures.
t-online.de: Prof. Radbruch, when are you waiting for a SARS-CoV-2 vaccine?
Prof. Radbruch: There are already vaccines against the new corona virus. The first ones are already in the early stages of clinical testing: at least 50 different products are rolling towards us. So the problem is not the vaccine itself, but its tests. You must ensure that, unlike the virus, it does not make you sick and still immunizes everyone. With SARS-CoV-2, we don’t even know how long immune protection lasts. However, the correct vaccine should protect us from it for a long time and this must be thoroughly clinically proven. The development of vaccines used to take several years, today we can count on the fact that within a year we have approved substances that work.
Prof. Dr. Andreas Radbruch is Scientific Director of the German Rheumatism Research Center and President of the European Federation of Immunological Societies. (Source: Gero Breloer)
There is currently a controversial discussion among scientists about loosening of contact blocks. For example, virologist Alexander Kekulé said in the daily news on April 4: “We cannot close until we have a vaccine.” How do you assess the current situation?
Here the question arises, what exactly is a closure? I think the term “closure” is a complete range of different measurements. What measures are necessary to bring the infection rate mainly from the exponential rate to a linear rate and what measures can be loosened or even eliminated from this point of view; This is a tough question. I think that politicians and scientists will have to have many conversations to slowly return to a somewhat more normal state.
In this context, collective immunity is often discussed. Do you see the time for this or do we need a better supply of protective material for the health system?
Mr. Kekulé said that the herd’s immunity had to be gradually developed. I think it is a bold statement. It is not entirely clear to me how one can gradually build such herd immunity with scientific advice. There will be more and more people infected and recovering on their own, as long as the infection rate does not drop to zero or a vaccine is available. In facilitating the measures, two aspects should not be forgotten: first, that the health system must function protecting employees as well as possible, and second, that especially the risk groups, that is, the elderly and people with previous illnesses, They are protected.
Is our health system ready for the peak of the crown crisis?
Our healthcare system is very well positioned to deal with the situation, apart from the fact that a large amount of protective material is no longer made in Germany for price reasons and there are bottlenecks. But that has now been recognized and will change direction there.
I think it would be a bit cynical to expose people at risk to possible infections, consciously or unconsciously. No matter how well the healthcare system is configured, after all, patients also die with us.
How do you assess the chances of successful treatment with existing medications that have not yet been specifically developed for the coronavirus?
The SARS-CoV-2 coronavirus is not fundamentally different from many other viruses, including other coronaviruses. There are a number of medications that interrupt the way other viruses live to contain the infection. Therefore, it is very sensible to test these medications now to see if they also work against SARS-CoV-2. However, to my knowledge, there are currently no well-controlled studies on this. What medicine with Covid-19 time really has to work.
Smaller studies have found evidence that Covid-19 patients treated with the antimalarial drug hydroxychloroquine recover more quickly from typical symptoms. How do you rate the possibilities of this product, but also the risks, for example of side effects, in relation to Covid-19?
Hydroxychloroquine works as follows: it interferes with the breakdown of hemoglobin in the blood pigment and causes Malaria– Pathogens die because they need blood pigment. However, it has been found to have a side effect: it interferes with the multiplication of cells and their ability to absorb particles. Therefore, this medication is particularly complicated. Not only is it used for malaria, but it also has an effect on rheumatic diseases. The agent is currently being tested for Covid 19 disease. As yet, however, no well-founded data is available. The studies that are sometimes cited are not significant enough. It is not yet scientifically possible to say that it works. Unfortunately
Is there any knowledge on how the use of immunosuppressive drugs, for example, for the treatment of rheumatism, affects an infection with SARS-CoV-2?
Studies are underway to determine if rheumatism medication suppresses certain aspects of the immune system in Covid-19. I mean, if this means answering that Corona virus inhibit It is not yet completely clear. But one thing can already be said from a rheumatological point of view: stopping the medication by the patients themselves does not make sense. Because if the rheumatism returns and there is a corona infection, the treatment becomes much more difficult. Rheumatism patients would have to take very strong immunosuppressants, which would be bad for their health, and nobody wants that. Therefore, patients are advised not to discontinue their therapies and to stop taking the medication themselves. If you have any questions about this, you should speak to your rheumatologist.
What protective measures do you recommend for rheumatics and patients with other autoimmune diseases regarding SARS-CoV-2?
Autoimmune diseases like rheumatism, Multiple sclerosis or chronic intestinal inflammation affects many people. About five to ten percent of the population suffers from it. They are also among the diseases that many only develop at an advanced age. Due to their weakened immune system, these patients fall into the Covid 19 disease risk groups. General protective measures that apply to both healthy and high-risk patients should be followed. This includes limited contact and strict adherence to hygiene rules, that is, washing hands and staying away from other people.
What do you expect from the therapeutic approach of passive immunization with antibodies from the blood of recovered people?
Passive immunization, that is, protection by antibodies from animals or other people, is a very old principle. It works very well, but only for a certain time. Because the antibodies are proteins that disappear from the blood of the vaccinated in a matter of weeks. At the moment, however, they offer surprisingly good passive protection. Passive immunization is very useful for people at high risk. Ultimately, this is a 1 to 1 situation, you must administer relatively many antibodies so that the person is also protected. You cannot protect many other people with donor serum.
Today we are in a situation where we can develop the next generation of passive immunization: through the synthetic production of therapeutic antibodies. That would be passive immunization 2.0. The genetic information for such antibodies is obtained from the blood of those who have recovered. In some diseases this is already happening and the antibodies are produced in large quantities using the technology. Therapeutic antibodies have been used in rheumatology for over 20 years.
Passive immunization has a certain advantage over virus vaccines: the antibodies used always consist of human proteins. Therefore, the approval procedures are not as complex as with active vaccines containing virus components.
How do you rate the different testing procedures in SARS-CoV-2? In your opinion, does a quick test produce a reliable result?
When taking the test, you should always consider what you want to test. The normal diagnostic test that was developed at Charité in Berlin is based on multiplying the virus’s genetic material in a so-called polymerase chain reaction so that it can finally be seen. The test therefore detects the virus. This takes a certain amount of time and you need a special lab for it. But it is a very reliable test that can detect even the slightest trace of the virus.
Covid-19 test: A blood test could also find antibodies. (Source: Future Image / imago images)
The antibody test, on the other hand, shows how humans react to the virus. You must be careful that the antibodies are specific and actually originate from the infection. The advantage here is that it can also demonstrate some protection with the antibodies. The downside is that the antibodies only appear late in the infection, after about a week or two.
Various rapid tests can detect both the virus and the antibodies. There are quick tests that work like a pregnancy test. The problem with these quick tests is that very few have been tested for reliability until now. That is, how often they are wrong and give false positive and false negative results. So far, there doesn’t seem to be a quick test for private use. They must be carried out in all medical offices, but not by private individuals. Therefore, the road to a rapid test, which can be used as a pregnancy test, remains a long one.
When is the earliest possible estimate of how long immunity will persist among those who have recovered?
In principle, an immune reaction is very violent in the first weeks. Antibodies are formed that are still detectable in the blood for half a year up to a maximum of one year. Unless an immune memory is formed. This presupposes that different types of lymphocytes work together, T and B lymphocytes, and then there are so-called memory cells that sit in different organs, such as the lungs or bone marrow for years. When the virus returns, the antibodies and these cells can react immediately.
After at least a year, you will discover how many of those who have recovered have a longer lasting immunity. This can last a lifetime, like measles. Those who developed measles as children or were vaccinated against the pathogen are still immune to it thirty years later. If this is the case with SARS-CoV-2 it can be estimated as soon as possible in one year. That is exactly the challenge for vaccine development. As far as possible, we need a vaccine that should only be given once and that already produces immunity that lasts a long time and does not have to be repeated every year.
Thanks for the interview, Prof. Radbruch!
